Lepidoptera (moths, butterflies, and caterpillars) are an uncommon cause of adverse reactions in humans. Most reactions to Lepidoptera are mild and self-limited; however, reactions in sensitive individuals and reactions to particular species can be severe and life threatening. Specific syndromes caused by Lepidoptera include erucism (cutaneous reactions from contact with caterpillars, moths, or cocoons), lepidopterism (systemic involvement), ophthalmia nodosa (ocular involvement), dendrolimiasis and pararamose (each with joint symptoms relating to a specific species of caterpillar), lonomism (a severe hemorrhagic disease related to Lonomia species), and seasonal ataxia (related to ingestion of Anaphe venata). In most cases, reactions to Lepidoptera can be treated symptomatically with prompt removal of offending hairs. Antipruritic or anesthetic topical preparations, topical steroids, and oral antihistamines are often used. In the case of potentially fatal Lonomia envenomation, an effective antivenin has been manufactured.
Although dermatitis caused by these moths is usually resistant to all therapeutic treatment, individualization of therapy based on symptoms led to successful treatment in all four cases.
We present frozen section as a novel method in the diagnosis of pili trianguli et canaliculi that may serve as a more time‐ and resource‐ efficient alternative to current gold‐ standard electron microscopy. In this case series, three children between ages one and four presented with blonde hair unable to be combed into place. Frozen section was performed and evaluated under light microscopy with easy visualization of the hair shaft abnormality, consistent with the diagnosis of pili trianguli et canaliculi.
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